Medication discrepancies probably occur for a variety
of reasons. Patients often incompletely understand their
medication regimens, especially at hospital admission, when
cognition may be impaired and medication lists, pill bottles,
and knowledgeable family members may be unavailable.
Medication informationfrom primary care offices and community
pharmacies is often unavailable, outdated, or underused.
When writing discharge medication orders, physicians
may rely solely on the patient’s current medication- discharge, patients may not understand the discharge medication
orders. After discharge, inaccuracies in the discharge
medication list, formulary restrictions, and lack of
communication among a patient’s many providers may also
contribute to the problem.